Minim Invas Neurosur
-
Minim Invas Neurosur · Dec 2008
Accuracy and clinical use of a novel aiming device for frameless stereotactic brain biopsy.
Aiming devices enable the use of neuronavigation systems for rigid instrument guidance mimicking the possibilities of a frame-based system without having a stereotactic frame affixed to the skull. The aim of the presented work was to investigate the phantom targeting accuracy of the Vertek aiming device (Medtronic Inc., Louisville, USA) and whether it can be safely and accurately applied in a concept of minimally invasive brain biopsy in which multi-modal image fusion, image-to-patient registration and head immobilization were based on a non-invasive vacuum mouthpiece. A plastic model of a head with 20 target beads broadly distributed around the head volume was used for determination of CT-based targeting accuracy. ⋯ The experimental results showed a similar accuracy to frame-based stereotaxy. The device facilitates trajectory alignment via two pivot joints and the actual depth and location of the biopsy needle can be monitored. Within the limitations of a preliminary study, brain biopsy may be accurately and safely performed for lesions > or = 12 mm.
-
Minim Invas Neurosur · Dec 2008
Case ReportsCombined treatment of ruptured aneurysm accompanied by intraventricular hemorrhage; neuroendoscopy and coiling: case report.
Subarachnoid hemorrhages with intraventricular hemorrhage (IVH) have been treated with aneurysmal clipping and ventricular drainage. We present a combined treatment with coiling and endoscopy: coiling of the ruptured distal anterior cerebral artery aneurysm and neuroendoscopic removal of IVH.
-
Minim Invas Neurosur · Dec 2008
Case ReportsEndoscopic endonasal management of petroclival cerebrospinal fluid leaks: anatomical study and preliminary clinical experience.
Endonasal management of most anterior cranial fossa cerebrospinal fluid leaks is a well established procedure, and even some middle cranial fossa cerebrospinal fluid leaks can be managed safely endonasally. Endonasal endoscopic management of leakages of the posterior cranial fossa represents an unique challenge. ⋯ Endonasal endoscopic management of well-selected petroclival cerebrospinal fluid leaks is feasible.
-
Having the experience of more than 4,000 hypophysectomy operations (150 cases per year on the average) by the senior author, initially performed via an intracranial, then a transseptal approach, now a direct endonasal approach, as a minimal invasive technique, is introduced to reduce the complications and for better comfort of the patient. It is the least traumatic route to the sella turcica, it avoids brain retraction, and it provides excellent visualization of the pituitary gland and lesions related to that structure. The brilliant increased vision of the surgical target offered by the endoscope can enable a more effective removal of the lesion, followed by superior clinical results and a reduction in the incidence of complications.
-
Minim Invas Neurosur · Oct 2008
ReviewAdvanced computer-aided intraoperative technologies for information-guided surgical management of gliomas: Tokyo Women's Medical University experience.
The availability of the intraoperative MRI and real-time neuronavigation has dramatically changed the principles of surgery for gliomas. Current intraoperative computer-aided technologies permit perfect localization of the neoplasm, precise estimation of its volume, and clear definition of its interrelationships with the eloquent brain structures. ⋯ Therefore, appropriate management of the wide spectrum of the intraoperative medical data and its adequate distribution between members of the surgical team for facilitation of the clinical decision-making is very important for attainment of the best possible outcome. Further progress in advanced neurovisualization, robotics, and comprehensive medical information technology has a great potential to increase the safety of the neurosurgical procedures for parenchymal brain tumors in the eloquent brain areas.